Archive for September, 2012

Shots were allegedly fired on Saturday night outside the taping of the BET Hip Hop Awards in Atlanta following a shoving match that broke out backstage between rappers Young Jeezy and Rick Ross.

According to TMZ sources, the two performers exchanged heated words during the ceremony and started pushing each other before their bodyguards and BET security intervened and separated the two men.

But that was apparently not the end of the incident. According to eyewitnesses, soon afterwards a member of Ross’s entourage went to the parking lot of the Boisfeuillet Jones Atlanta Civic Center and pulled out a gun, firing several shots.

Fisticuffs: Rapers Rick Ross, right, and Young Jeezy, left, allegedly got into a shoving match backstage at the BET Hip Hop Awards, which resulted in shots being fired

No injuries were reported, and police have denied that shots were in fact fired.

Sources said that the concert venue was temporarily shut down during a musical tribute to the late hip hop mogul Chris Lighty. The building later reopened and the taping of the awards show continued with heightened security.

More…

According to the Atlanta Police Department, neither Young Jeezy nor Rick Ross was arrested in connection to the altercation.

Rick Ross, 36, and Young Jeezy, 34, have not enjoyed a good relationship in the past, but lately the two appeared to be on good terms.

Escalation: Sources said a member of Rick Ross’ entourage went to the parking lot after the backstage altercation and fired shots

But on Saturday, Hot 97 DJ Funkmaster Flex tweeted that things between the rappers came to a head when members of their cliques crossed paths backstage.

At around 9.30pm, the DJ tweeted: ‘Jeezy and Rick Ross just had words backstage!! Pushing and shoving!!!’

Minutes later, he posted an update, telling his followers: ‘Beef just spread to the parking lot!!!’ before tweeting, ‘Shots fired in parking lot!!! Gunman arrested!!! Back to the show and the Club later!!!’

More trouble: Eyewitnesses said that Ross’ protégé Gunplay was involved in a fight with members of 50 Cent’s (pictured) G-Unit camp

Multiple sources confirmed to MTV News that Ross’s protégé Gunplay was also involved in a fight with members of 50 Cent’s G-Unit camp.

Atlanta Journal Constitution reported that Jeezy was arrested in 2005 for carrying a concealed firearm without a permit and in 2008 for DUI, while Ross was arrested in 2008 for gun and marijuana charges, and in 2011 for possession of marijuana.

Actress Lindsay Lohan was allegedly assaulted early this morning by a man she had invited back to her room at a posh New York City hotel, police said.

The 26-year-old actress told police she met Christian LaBella, 25, at celeb hot spot 1 Oak and invited him, along with three of her friends, back to her room at the W Hotel in Union Square early Sunday morning.

Once in the room, Lohan told police she found pictures of herself on LaBella’s phone and confronted him. LaBella allegedly threw her on a bed when she did not hand over his phone, leaving her with scratches, police said.

According to police, Lohan then ran out and down several flights of stairs where she was again confronted by LaBella, who she said tried to choke her from behind.

At this point, she told police, she pulled the hotel fire alarm disabling the elevators and summoning police to the scene, police said.

Anticipating LaBella was in the stairwells, officers covered all of the hotel’s exits until he was apprehended as he was attempting to leave, police said. He was identified by Lohan and a friend.

LaBella, of Valley Village, Calif., was charged with two misdemeanor counts of third-degree assault and two counts of harassment.

It wasn’t clear whether the 25-year-old had hired an attorney or how he intends to plea.

A representative for the actress said she was “fully cooperating with the investigation.”

Two days ago, the actress spoke out against violence on Twitter.

“Don’t be afraid to speak to someone about verbal, sexual, or any kind of physical abuse. It’s your life & you are in control of your destiny” she tweeted.

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The Wall Street Journal reports that criminal charges against LaBella have been dropped. LaBella now only faces a harassment complaint, but according to a law-enforcement official, he cross-filed the same complaint against Lohan.

Realizing it could not allow China to monopolize international discourse on the Senkaku Islands territorial dispute, the government has changed course and begun to aggressively speak out on Japan’s legitimate sovereignty over the uninhabited islands.

Government officials until now had not commented about the issue because the official stance is that no territorial dispute exists over the islands, which the Chinese refer to as the Diaoyu Islands.

The Asahi Shimbun

Referring to the change in course at a Sept. 28 news conference, Chief Cabinet Secretary Osamu Fujimura said, “While there was no need in the past to comment because a territorial dispute did not exist, with (China) transmitting only its side of the argument, we felt there was also a need to explain our position just as strongly.”

In recent days, China has openly criticized Japan’s claim to the islands and has not only commented about the issue in international forums but has also taken out advertisements in Western media laying out its arguments.

At a Sept. 27 speech at the United Nations General Assembly, Chinese Foreign Minister Yang Jiechi said, “There is no way of changing the historical fact that Japan stole the Diaoyu Islands.”

In response, Kazuo Kodama, Japan’s deputy permanent representative to the United Nations, said at the same assembly meeting that China had never challenged Japanese sovereignty over the islands until the 1970s and called the argument that Japan stole the islands an error.

Foreign Ministry officials had prepared several counter-arguments depending on what Yang said in his U.N. speech. The four situations considered were: if he only argued that the islands were Chinese territory; if he called as invalid the placing of the islands under U.S. administration through the San Francisco Peace Treaty and argued that the islands were always Chinese territory ever since the end of World War II; if he referred to Chou En-lai’s and Deng Xiaoping’s comment about tabling the Senkakus issue until future generations could resolve it; and if he made arguments that touched upon past wars.

A Chinese marine surveillance vessel, foregound, cruises side by side with a Japan Coast Guard ship within Japan’s territorial waters near the Senkaku Islands on Sept. 24. (The Asahi Shimbun)

Yang is not the only high-ranking Chinese official who has made increasingly virulent comments since Japan assumed national ownership of the islands.

The decision by the Noda administration to change its stance was made on Sept. 22 before Noda left to attend the U.N. General Assembly meeting in New York. Discussions were held among high-ranking government and Foreign Ministry officials.

While in New York, Noda met with the leaders of five nations and explained to each that the Senkakus were Japanese territory.

At a news conference before returning to Japan, Noda said, “I explained Japan’s position by utilizing the U.N. General Assembly to the fullest.”

In explaining why Japan has not until now explained its position to leaders of third nations, a high-ranking Foreign Ministry official said, “If a territorial dispute did not exist, it would be meaningless to respond to any argument made by China.”

Another reason Japan likely long kept quiet on the issue was to avoid agitating Beijing.

After the Noda Cabinet purchased some of the Senkaku Islands from private ownership, making them state property, on Sept. 11, Japanese embassies abroad have repeatedly sent in reports about China buying ads in various overseas media arguing for its territorial claim over the islands as well as about local media reports which paint Chinese arguments as though they were facts.

Foreign Minister Koichiro Genba held discussions with high-ranking ministry officials about what response to take.

In mid-September, instructions were sent out to overseas embassies to strengthen their efforts to transmit Japan’s stance on the issue.

Diplomats at overseas embassies have begun briefings of high-ranking officials at media organizations as well as scholars in Western nations.

On Sept. 26, the Japanese Consulate-General in Los Angeles issued a protest to a local newspaper, calling one report biased in China’s favor.

On Sept. 27, the Foreign Ministry also issued a document listing what it calls the facts about the Senkakus issue.

Photo: An aerial view shows a Japan Coast Guard patrol ship (3rd from top) spraying water towards a fishing boat from Taiwan as Taiwan’s Coast Guard vessel (4th from top) sprays water near the disputed islands in the East China Sea, known as Senkaku in Japan, Diaoyu in China and Tiaoyutai in Taiwan, in this photo taken by Kyodo September 25, 2012. Japanese Coast Guard vessels fired water cannon to turn away about 40 Taiwan fishing boats and eight Taiwan Coast Guard vessels from waters Japan considers its own on Tuesday in the latest twist to a row between Tokyo and Beijing. REUTERS/Kyodo

At the same time, the government has not spoken out as strongly about the territorial dispute with South Korea over the Takeshima islets, in part because Seoul has not been as aggressive about making its claim in the international arena.

“The Obama foreign policy is unraveling literally before our eyes on our TV screens. And so what Mitt Romney is going to do is lay out a very different vision for foreign policy. One, that is a policy of strength that I would articulate or claim the president’s policy is one of weakness. We’re seeing the ugly fruits of the Obama foreign policy unravel around the world on our TV screens.”

It looks like Obama’s policy of leading from behind was a complete failure.

An aerial photo shows a Chinese marine surveillance ship Haijian No. 66 (R) cruising next to Japan Coast Guard patrol ships in the East China Sea, known as Senkaku isles in Japan and Diaoyu islands in China, in this photo by Kyodo September 24, 2012. REUTERS/Kyodo

By Jennifer Saba

(Reuters) – With world leaders gathered in New York for the United Nations General Assembly, Chinahas taken its dispute with Japan over the ownership of a chain of islands to the ad pages of major American newspapers.

China Daily, an organ of the Communist Party and the country’s official English-language daily newspaper, took out full-page-spread advertisements on Friday in the New York Times and the Washington Post.

The ad’s headline asserts “Diaoyu Islands Belong to China” over a color picture of the string of islands in the East China Sea. It says the islands “have been an inherent territory of China since ancient times.”

Ownership of the islands has become a major flashpoint in deteriorating Sino-Japanese relations. The potentially gas-rich uninhabited islets, administered by Japan for years, have been claimed by China and Taiwan, where they are known as Diaoyu and Tiaoyutai, respectively.

The festering dispute figured prominently at the General Assembly this week as U.S. Secretary of State Hillary Clinton urged China and Japan on Thursday to let “cooler heads” prevail.

In September, Japan brought the chain – known to the Japanese as the Senkaku Islands – under state control through a “purchase” from a private owner.

A spokesperson for the Japanese consulate in New York defended Japan’s ownership of the islands but would not comment on the Chinese ads.

WASHINGTON (AP) — If you or an elderly relative have been hospitalized recently and noticed extra attention when the time came to be discharged, there’s more to it than good customer service.

As of Monday, Medicare will start fining hospitals that have too many patients readmitted within 30 days of discharge due to complications. The penalties are part of a broader push under President Barack Obama’s health care law to improve quality while also trying to save taxpayers money.

About two-thirds of the hospitals serving Medicare patients, or some 2,200 facilities, will be hit with penalties averaging around $125,000 per facility this coming year, according to government estimates.

Data to assess the penalties have been collected and crunched, and Medicare has shared the results with individual hospitals. Medicare plans to post details online later in October, and people can look up how their community hospitals performed by using the agency’s “Hospital Compare” website.

It adds up to a new way of doing business for hospitals, and they have scrambled to prepare for well over a year. They are working on ways to improve communication with rehabilitation centers and doctors who follow patients after they’re released, as well as connecting individually with patients.

“There is a lot of activity at the hospital level to straighten out our internal processes,” said Nancy Foster, vice president for quality and safety at the American Hospital Association. “We are also spreading our wings a little and reaching outside the hospital, to the extent that we can, to make sure patients are getting the ongoing treatment they need.”

Still, industry officials say they have misgivings about being held liable for circumstances beyond their control. They also complain that facilities serving low-income people, including many major teaching hospitals, are much more likely to be fined, raising questions of fairness.

“Readmissions are partially within the control of the hospital and partially within the control of others,” Foster said.

Consumer advocates say Medicare’s nudge to hospitals is long overdue and not nearly stiff enough.

“It’s modest, but it’s a start,” said Dr. John Santa, director of the Consumer Reports Health Ratings Center. “Should we be surprised that industry is objecting? You would expect them to object to anything that changes the status quo.”

For the first year, the penalty is capped at 1 percent of a hospital’s Medicare payments. The overwhelming majority of penalized facilities will pay less. Also, for now, hospitals are only being measured on three medical conditions: heart attacks, heart failure and pneumonia.

Under the health care law, the penalties gradually will rise until 3 percent of Medicare payments to hospitals are at risk. Medicare is considering holding hospitals accountable on four more measures: joint replacements, stenting, heart bypass and treatment of stroke.

If General Motors and Toyota issue warranties for their vehicles, hospitals should have some similar obligation when a patient gets a new knee or a stent to relieve a blocked artery, Santa contends. “People go to the hospital to get their problem solved, not to have to come back,” he said.

Excessive rates of readmission are only part of the problem of high costs and uneven quality in the U.S. health care system. While some estimates put readmission rates as high as 20 percent, a congressional agency says the level of preventable readmissions is much lower. About 12 percent of Medicare beneficiaries who are hospitalized are later readmitted for a potentially preventable problem, said the Medicare Payment Advisory Commission, known as MedPAC.

Foster, the hospital association official, said medication mix-ups account for a big share of problems. Many Medicare beneficiaries are coping with multiple chronic conditions, and it’s not unusual for their medication lists to be changed in the hospital. But their doctors outside sometimes don’t get the word; other times, the patients themselves don’t understand there’s been a change.

Another issue is making sure patients go to their required follow-up appointments.

Medicare deputy administrator Jonathan Blum said he thinks hospitals have gotten the message.

“Clearly it’s captured their attention,” said Blum. “It’s galvanized the hospital industry on ways to reduce unnecessary readmissions. It’s forced more parts of the health care system to work together to ensure that patients have much smoother transitions.”

MedPAC, the congressional advisory group, has produced research findings that back up the industry’s assertion that hospitals serving the poor, including major teaching facilities, are more likely to face penalties. But for now, Blum said Medicare is not inclined to grade on the curve.

“We have really tried to address and study this issue,” said Blum. “If you look at the data, there are hospitals that serve a low-income patient mix and do very well on these measures. It seems to us that hospitals that serve low-income people can control readmissions very well.”

Under Obama’s health care overhaul, Medicare is pursuing efforts to try to improve quality and lower costs. They include rewarding hospitals for quality results, and encouraging hospitals, nursing homes and medical practice groups to join in “accountable care organizations.” Dozens of pilot programs are under way. The jury is still out on the results.

“This whole race is going to be turned upside down come Thursday morning,” the Republican governor from New Jersey told CBS “Face The Nation” host Bob Schieffer Sunday. Christie pointed to the Republican presidential nominee’s performance in the primary debates, saying the debates will be an opportunity to speak with out being “filtered” or “spun” by Romney’s critics.

New Jersey Gov. Chris Christie accused President Obama of lying this morning after I showed him an advertisement being run by the Obama campaign attacking Mitt Romney’s economic plan and accusing the former Massachusetts governor of wanting to cut taxes for the wealthy. I asked Christie how he would respond if it were him debating the president Wednesday night during the first presidential debate.

“Stop lying, Mr. President…Governor Romney is not talking about more tax cuts for the wealthy. In fact, what he said is that the wealthy will pay just as much under a Romney administration as they pay today,” Christie said. “I love those ads. I mean, you know, the president gets to say things like a million new manufacturing jobs, well, how, Mr. President? We’re still waiting. Four trillion reduction in the debt. Really, Mr. President? How? Simpson-Bowles? You haven’t endorsed your own plan. Nor has he come forward with a plan. I mean, it’s a great ad. I have no doubt about that. It sounds really nice, and it looks nice. But there’s nothing substantive there.”

President Obama released an advertisement last week that accused GOP presidential nominee Mitt Romney of sticking with policies that led to the financial crisis in 2008.

“Governor Romney believes that with even bigger tax cuts for the wealthy, and fewer regulations on Wall Street, all of us will prosper. In other words, he’d double down on the same trickle down policies that led to the crisis in the first place,” Obama said in the two minute advertisement.

I spoke with White House senior adviser David Plouffe after my interview with the governor of New Jersey and he called the accusation that the president was lying, “not true.”

“Strong words and not true. Listen, analysts have looked at this. Someone who makes over $3 million a year would get over a $250,000 tax cut if Governor Romney’s plan were to be enacted. And let’s just step back. It’s a $5 trillion tax cut, $2 trillion in defense spending, by the way, that our Pentagon and our military leadership says we don’t know, another $1 trillion to extend all the Bush tax cuts. That’s $8 trillion,” Plouffe said. “The notion that somehow by closing loopholes for the wealthy that the middle class is going to be held harmless — you know, the middle class needs to understand, if — if Mitt Romney wins this presidential election, they’re going to be paying the bill, not to reduce the deficit, not to reduce jobs, but to give huge tax cuts to the wealthy,” he said.

“So we’re happy to have that debate, because we think the facts are on our side,” Plouffe said.

I also asked Christie if Romney would shake things up on Wednesday and the New Jersey governor told me that the debate would be a positive turning point for Romney.

“I mean, every time Mitt Romney has been confronted in this campaign with one of these moments, he has come through in the debate and performed extraordinarily well, laying out his vision very clearly, and also contrasting himself and his vision with whoever his opponent was at that time,” Christie said. “So I have absolute confidence that, when we get to Thursday morning, George, all you’re going to be shaking your head, saying it’s a brand-new race with 33 days to go. ”

For his part, Plouffe said Romney has more to gain from the debate and added that the president would lay out his plan for the next four years.

“We believed all along that Governor Romney probably has more benefit out of this debate potentially than we do,” said Plouffe. ”But what we’re going to tell the American people on Wednesday night, as we have through the whole campaign, is exactly where we are as a country, where we need to go, how we rebuild an economy that makes the middle class secure, and with great detail so people understand, when — if this president gets re-elected, what he’s going to do for them, for the middle class, in the next four years,” he said.

We cannot vote for Barack Obama for a second term for a number of important reasons.

First, “It’s the economy, Stupid.”

This little phrase pushed George Herbert Walker Bush out of the White House and Bill Clinton into the Oval Office in 1992.

And don’t forget, Bush had just engineered the largest military coalition since World War II to get Saddam Hussein and his forces out of Kuwait, he had been the Vice President for eight years before that and had also been the Ambassador to China and the Director of Central Intelligence. Before that he had been a World War II fighter pilot, shot down over the Pacific and rescued by a submarine!

If America voted résumés, Bill Clinton, then the former Governor of Arkansas, should not have had a chance.

But Americans often vote their “pocketbooks” or “kitchen table” issues.

Under President Obama, average annual household income has a dropped by $4,000, while household income rose in Massachusetts by $5,000 while Romney was governor.

So on the economy, Obama is in trouble.

Leaders within his own Democratic Party have had a hard time with the basic question: “Are Americans Better of now than they were four years ago?” Most thinking people would say “no.”

On immigration President Obama isn’t doing too well either.

Univision, the Spanish speaking network, asked President Obama one of his first difficult questions of the election year when they questioned him on how he did matching his promises on immigration to Latinos.

Univision also hit the president on the ethics of his Administration, asking if he should not have fired Attorney General Holder by now.

America was the victim of an act of war not too long ago when extremists attacked the American Consulate in Benghazi, Libya, killed (and perhaps raped) the American Ambassador and also killed four other American employees of the Consulate. Then they ransacked and burned the American Consulate, always considered sovereign property, and torched the American flag.

And all this on the anniversary of the attacks by Muslim extremists on September 11, 2001, which destroyed the World Trade Centers in New York, a part of the Pentagon, and Flight 93 which, after it was hijacked by terrorists, crashed nose first into the Pennsylvania country side killing all aboard.

Given all that evidence, the White House actually balked at calling the attack in Benghazi a planned terrorist event, much less an act of war. The President’s hand-picked Ambassador to the United Nations, Susan Rice, actually went on TV the Sunday after the attack to declare “Our current best assessment, based on the information that we have at present, is that, in fact, what this began as, it was a spontaneous – not a premeditated – response to what had transpired in Cairo.”

Photo: Susan Rice (ABC News)

Never mind that the government of Libya almost immediately declared the event a planned terror attack because it occurred on 9/11 and the terrorist were in possession of Rocket Propelled Grenades (RPGs) — not your every-day walking around hardware even in troubled Libya.

Almost simultaneously, the President visited the United Nations in New York without meeting with one international leader — only the women from “The View.”

That despite a request by America’s closest ally in the region, Israel, to host a meeting with Israeli Prime Minister Benjamin Netanyahu.

So just as the president’s critics were saying he was more controlled by events than one who shaped events to attain U.S. interests, after denying Netanyahu a visit in the White House, the Israeli leaders gave a speech to the United Nations General Assembly making his case for a “red line” for Iran.

President Obama had to phone Netanyahu after the Israeli leader’s U.N. speech to find out what his best ally in the Middle East had in store for the world and the U.S. next — instead of participating in a coordinated effort to dissuade Iran from completing a nuclear weapon.

Don’t forget, for Israel, Iran with a nuclear weapon is an unacceptable existential threat — because Iran has been crowing for years that it would eliminate the State of Israel from the face of the earth.

So some folks on Twitter poked fun at Netanyahu and his goofy cartoon but don’t forget: folks have tried to kill off all the Israeli’s once or twice before so they take these things kinda seriously, given the Holocaust and all….

To Obama, that seems hardly very important.

And then we have China.

China has been busily browbeating its Asian neighbors in an effort to confiscate any island near any potential untapped oil deposits.

Japan has been the chief victim of this assault in the East China Sea; but the Philippines, Vietnam and others are surely in China’s way in the South China Sea.

And what has America said about China’s activities? Just about nothing.

Finally we have health care. President Obama’s Health Care Lollapalooza may help some but it is certainly straining moral and ethically thinking people beyond their limits.

For the first time in American History, Catholic Bishops are actually telling voters NOT to vote for this Democrat President because he is a threat to the sanctity of human life.

In fact, news is buzzing around that several countries that have tried socialized medicine are having trouble keeping old people alive because they are just too dog gone expensive as patients.

Above: We know you hate then and their health care costs a bundle but do we have to kill them?

Finally, we have no idea how America can service the debt and pay for the new health care plan without eviscerating the American military. And if this happens, America will no longer be the voice of freedom and human rights and democracy in the world — which should be unacceptable to many.

So I am with Jay Leno: we have given Barack Obama enough time to show us what he can do.

And it is time for “Change.”

John Francis CareyPeace and Freedom

Psychologists told us when they read the New York Times article we gave them, “This man does not seem honest. He sounds like he has something to hide….” The article By Jodi Kantor
was published in The New York Times on July 30, 2008 and is part of the related post at the link below:

President Obama’s “You didn’t build that” gaffe showed real disrespect, misunderstanding and derision for American Entrepreneurs and business owners that should disqualify any American from high office:

The key argument in favor of the individual health insurance mandate, which was upheld last month by the Supreme Court in a 5-4 vote, was that everyone uses health care eventually. Therefore, it is only fair that everyone pays into the insurance pool. Without a mandate, when access to affordable coverage becomes guaranteed in 2014, some people will simply wait until they get sick before buying a plan.

By Merrill Goozner
The Fiscal Times

Chief Justice John Robert didn’t buy that logic. He became the fifth and deciding vote by declaring the mandate a tax, which the government has an unquestionable right to levy. He otherwise agreed with the dissenters who said people couldn’t be compelled to buy a product – in this case insurance – simply because one day they were going to end up in a hospital bed needing coverage.

A new issue brief from the National Institute of Health Care Management adds grist to the mill of those who rebelled against the universal insurance mandate. The study showed that in 2009 half the population – fully 150 million people – spent an average of just $236 per person on health care. That was a paltry $36 billion for the entire group out of $1.3 trillion in personal health care expenditures.

On the other side of the use spectrum, however, just five percent of the population – about 15 million people – spent a whopping $623 billion or about half of all personal health care expenditures. That came to nearly $41,000 per patient.

And if one looks at just the top 1 percent of health care “spenders” – those who were often battling life-threatening or crippling illnesses like heart disease, diabetes, cancer or dementia – they averaged over $90,000 per patient per year. These three million people accounted for over 20 percent of the total health care tab.

The study serves as a cautionary note to advocates on the left or right who think eliminating waste or giving “consumers” a greater financial stake in health care decision-making will be magic bullets for holding down rising health care costs. “We have to get a handle on who these people are and develop more cost-effective strategies to help them,” said Nancy Chockley, president of the NIHCM, which receives most of its funding from various Blue Cross Blue Shield insurance organizations. “Long-term we have to prevent them from getting that far.”

The study showed that the vast majority of big spenders were older and often had multiple chronic conditions such as heart disease, diabetes, asthma and arthritis. Many times those conditions were associated with obesity. Though people 65 and older and eligible for Medicare made up just 13 percent of the population, they made up 40 percent of the high-spending group.

People in the workforce who were privately insured and spent big on health care also suffered disproportionately from multiple chronic conditions. A previous study cited in the report showed that just 7 percent of people in the high-spending “five percent” had no previous chronic condition, in other words, they were stricken without warning by cancer or suffered a bad accident.

“If you look at what’s driving the growth in health care spending, half is due to the increase in chronic health conditions,” said Ken Thorpe, a professor of preventive medicine at Emory University and chairman of the corporate-backed Partnership to Fight Chronic Disease. “Prevention is crucial to holding down costs long-term.”

Thorpe’s group is promoting strategies like the Diabetes Prevention Program, which has been shown to reduce the number of people who matriculate into the high-cost category. The counseling and exercise program, which has been successfully tested at a handful of YMCA’s across the country, reduced the number of pre-diabetics, who were overweight with elevated blood sugar, who developed full-blown diabetes by 58 percent. “We have evidence-based programs that works if we could just build them out,” he said.

Yet prevention strategies will do little in the short-run to bend the cost curve down. People in the high-spending category, whenever they arrive there, are likely to remain there for the rest of their lives.

The insurance company-backed NIHCM’s takeaway from the study was that the new state exchanges set up under health care reform either must take steps to guarantee that high-cost patients are evenly distributed among competing plans or must “risk adjust” the size of payments to insurers. “If you’re an organization with a great reputation for treating diabetics, guess who you’re going to get? Lots of diabetics,” Shockley said. “There has to be adequate risk adjustment.”
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